Healthcare: What’s Next?

As you’ve certainly heard, the Senate tax-cut-for-the-wealthy-at-the-expense-of-the-sick has met it’s death. Yes, Mitch will hold a “Repeal Only” bill next week, but that’s not going anywhere either. You may wonder why that vote is being held, and the answer is rather simple: Donald Trump is intellectually impaired. The White House has put a lot of pressure on Mitch to hold said vote because first, while #NotMyCheeto cannot name all 52 GOP senators, he holds out some hope that he can corral people to vote for it, and second, because he views the vote along the lines of a “loyalty” vote. He wants that opportunity to take names on who is “fir ‘im, and agin ‘im”. Also, Mitch would rather be a loser than a quitter.

So what’s left? Basically the option that cost John Boehner the speakership: bipartisanship. The other option would be for #NotMyCheeto to cease the insurance company payments, and dismantle the individual mandate via Executive Order, which would throw 32 million people off the roles of Exchange-based insurance as well as Medicaid as soon as the insurance companies could get new rate levels through the state insurance commissioners. While Trumpkin couldn’t care less, since his criminal family isn’t affected, and there’s no impact on Russians, the House and Senate DO care because the full house and a third of the Senate is up for re-election next year, and voters never forget who took something from them.

At the White House yesterday, Trumpkin said: “We’re not going to own it. I’m not going to own it. I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us.” Idiot.

While the Freedom Caucus actually believes failure of the healthcare sector is okay, and there are some pretty dull wits there, most of Congress is well aware that the healthcare sector is 1/6th of the overall economy, and a lot of those 32 affected humans are actual voters.

There actually are good ideas that would shore up the markets: take Medicaid cuts off the table (and we’ll come back to that), commit via legislation to keep the insurance company supports for low and moderate income people in place, recommit to the individual mandate to preclude a dual-market system as proposed in the Cruz-Lee amendment, and include reinsurance in the package. These steps would stabilize the market, get insurers to cover people in those counties currently looking at no providers for CY 2018, and keep people using health care services as insured participants. (A side point is that the Feds being allowed to negotiation drug prices for Medicare as is accomplished for the VA, along with the importation of drugs would save a lot of money and make the pot for healthcare payments larger from those savings.)

If these things are not accomplished, we return to a time when emergency rooms were used for basic healthcare, costs overall were higher, and outcomes were poorer.

There are enough moderate Republicans in both the House and Senate to work with Democrats to pass this sort of legislation.

Back to Medicaid. When it was passed in 1965, it was narrower than it is today. It originally only covered the most disabled, some children, and poor seniors. It was, and remains, a Federal-State partnership program, which is why there is such disparity in benefits between richer and poorer states. Also remember that in 1965 people didn’t live as long as they do now, and many things that were killers in the ’60’s are now more long-term chronic conditions. There were no MRIs, PET Scans, immunotherapy for cancer, stents, truly effective cardiac drugs, etc. Medical care has become more expensive for many reasons, but no one can doubt that advances have increased lifespans, and thus the cost to Medicaid for the elderly, and the ability to keep severely disabled human beings alive. The current GOP objection to Medicaid is that it now covers able-bodies adults who just happen to be poor. There’s a good solution for this, and it’s called “Medicare for All” which is, sadly, not a viable option in 2017 since most people don’t understand mathematics.

Non-STEM Republicans say that taxes need to be raised to fund Medicaid. They also claim they need more funding to underwrite exchange-based insurance for poor people, funded by taxes. They fail to understand how Medicare-for-All would work. I can do math, and I say that if I pay premiums now to a health insurance company that costs 15-18% in overhead, and instead I could pay taxes that would cover my premiums to a company that charges 2% in overhead, my taxes would go up an amount equal to the premiums paid AND there would be extra money (13 – 16%) available to help pay for someone else’s premiums via taxes. Yes, really. Medicare costs 2% to do what private for-profit insurance companies charge at 15-18% for the same administrative overhead. And oh yeah, that extra money? It doesn’t go to the cost of healthcare services paid to doctors, hospitals and other providers, it doesn’t go to the people who process the claims — it goes to PROFIT to the stockholders. Just sayin’.

I digress — the current problem is how to prevent millions of Americans from losing all their healthcare coverage and that answer is bipartisanship to work out interim and long-term solutions. Will Mitch and Paul agree? Hopefully. McConnell is a partisan, but he’s an old hand, and understands what is at stake. Ryan is an ideologue but he’s not stupid, so maybe.

As always — keep the pressure up on your reps because they respond to pressure a lot of the time. And remember, we’ve got a hard deadline of end of September to raise the debt ceiling cleanly – if we don’t get that done, the recession of 2007-2009 is going to look like a day at the beach.

One thought on “Healthcare: What’s Next?”

I would add in one more “fix” to be included in a bi-partisan bill — expanding subsidies to cover those in the Medicaid hole in the states that opted out of the Medicaid expansion. Not a perfect solution, but the courts created this problem.